This is Steven Salzberg's blog on genomics, pseudoscience, medical breakthroughs, higher education, and other topics, including skepticism about unscientific medical practices. Here's where I can say what I really think about abuses and distortions of science, wherever I see them.

Parents: ADHD drugs don’t work

If you want to start an argument, try telling a parent – any parent – how to raise their kids. So I'm going to preface this by saying that I'm just trying to make parents aware of something that might concern them. One of the most controversial issues among parents of school-age children today is the shockingly large number of children who are being treated with drugs to control their behavior, especially those children who have been diagnosed with attention-deficit hyperactivity disorder (ADHD). Now it appears that these drugs simply don’t work, except in the short term. The results of a scientific study reported this past week showed that long-term use of drugs to children with ADHD doesn’t provide any benefit over behavioral therapy. Not only that, but children who took medication ended up, on average, one inch shorter than children who didn’t. That’s right: ADHD drugs stunt children’s growth.

This seems to be rather shockingly bad news for the ADHD drug manufacturers. The news was reported on the front page of the Washington Post and in many other media outlets. The study, an 8-year followup of the Multimodal Treatment Study of Children With ADHD (MTA), was reported in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP). The study divided children into 4 groups: medication (M), behavior therapy (B), both treatments (M+B), or no treatment. The authors of the study had reported in 1999 – with great fanfare – that children who received drugs (M and M+B) did better than children who only had therapy (B) after 14 months and at 2 years followup. In other words, over the short term, the drugs seemed to work. As the Washington Post reported: “Because children given drugs alone appeared to do about as well as those treated with both drugs and talk therapy, the study skewed treatment in the direction of medication.”

However, over longer time periods, the drugs (including Adderall and Concerta, two of the most commonly prescribed drugs for ADHD) didn’t help at all – and they stunted growth. Children who took ADHD drugs for 3 years or longer were an average of one inch shorter than children who didn’t take drugs. The study looked at “grades earned in school, arrests, psychiatric hospitalizations, [and] other clinically relevant outcomes,” and found no differences in children given drugs compared to children given only behavioral therapy.

What should be even more disturbing is that this isn’t really news at all – it was reported two years ago, in 2007. The same authors reported then, in a 3-year followup study, that “treatment groups did not differ significantly on any measure at 36 months.” In other words, the benefits of drugs disappeared by 3 years after treatment started. Some of the scientists involved have downplayed these results, but one, William Pelham, was quoted in the Post saying his colleagues are “embarrassed to say they were wrong and we led the whole field astray.”

Another scientists leading the study, Peter Jensen, shot back that Pelham was biased against drugs. However, Jensen has been pushing drug therapy quite publicly for years. In the press release from the National Institute of Mental Health after the 2007 report, he said that “medication can make a long-term difference for some children if it's continued with optimal intensity.” This despite the fact that the 2007 results indicated that medication was not providing any benefit over behavior therapy, results that appear even stronger now. In contrast, William Pelham was already saying in 2007 that ADHD drugs were “all risk and no reward.”

It’s worth noting also that NIMH heavily promoted the initial results of this study back in 2000, and its website still states that “combination treatments as well as medication-management alone are both significantly superior to intensive behavioral treatments and routine community treatments in reducing ADHD symptoms.”

Reporter and blogger Maggie Mahar tried to draw attention to the story in 2007, but the U.S. media simply didn’t pick up on the story. Mahar also pointed out that “drug manufacturers have a serious interest in keeping the U.S. discussion on ADHD married to the medical-disease model.”

All of this made me wonder if Peter Jensen, who seems determined to continue to support the use of drugs to treat ADHD, might have ties to pharmaceutical companies. It took me only a few minutes to discover that he has received funding or grants from: UCB-Pharma, Cephalon, Novartis, McNeil Consumer & Specialty Pharmaceuticals, and Janssen Pharmaceutica. I found confirmation of these ties here. Novartis and UCB-Pharma are manufacturers of ADHD drugs (Ritalin or methylphenidate), and Cephalon makes Provigil, which they attempted to promote as an ADHD drug for years until the FDA rejected it.

Far too many of our children – primarily boys, who are diagnosed with ADHD 3-4 times more often than girls – are being medicated for ADHD. There is ongoing controversy, which I won’t get into here, over whether ADHD is grossly overdiagnosed. Whether ADHD is correctly diagnosed or not, though, it now seems clear that putting children on drug therapy might cause them long-term harm (stunting their growth) while only providing temporary, short-term changes in behavior.

My niece was on Adderall and Seroquel due to having violent outbursts at school. She was being bounced from drug to drug and then my wife and I took her in. We weened her off of the drugs and made sure she ate right and reinforced basic rules with her. Within 6 months she was a different child. By 18 months her father wanted her back. Within days of going back she was placed back on meds and ballooned in weight. Her violent behavior started again. 6 years have gone by and she's morbidly obese, is not attending school, and spends most of her time either hanging out at the animal shelter or playing in the ditch near her house. Not normal activities for a 15 year old girl.

Unfortunately her parents and many others out there are just too lazy to spend the time necessary to get their kids on track and it kills me every time I see her and kids like her who just need someone to put forth some effort.

I have been prescribed amphetamines for 11 years. I feel great and I get work done, it's a win win. Of course, I only take them when I feel they may be useful for the situation at hand; my dosing is not a daily ritual. Daily usage is going to create a tolerance, and the dose can only be increased to a certain point before addiction will manifest with ease. The point I'm getting at: These medications work just fine in the long term when combined with common sense.

I have struggled with ADHD my entire life. I was never diagnosed until college, where medication changed my life. To say that ADHD is a racket is making this all a bit too black and white. Are children being overdiagnosed? Sure, but that does not mean ADHD doesn't really affect people. I am 27 now and take Concerta every day. If I don't, I can barely sit still in a chair, let alone do work. I do feel though that the drugs are having less of an effect, and I am resisting going up in dosage because it raises your blood pressure. If I didn't have Concerta, I honestly believe I would not have had any real success in my life. That drug changed my life.

I need to make a comment here because otherwise my wife is going to think I am the belt-advocating anonymous. Like anonymous, I am sure I would have been diagnosed with ADHD if the diagnosis had existed in the early 80s. In hindsight, it is clear I was just evil and deserved what I got (a red ass, e.g.). But these are just anecdotes and should not be used as substitute for scientific research. So, Steve, thanks for this great post.

Chuck: according to the most recent study, at the 8-year mark: "As a group, despite initial symptom improvement during treatment that is largely maintained after treatment, children with combined-type ADHD exhibit significant impairment in adolescence." In other words, regardless of the treatment (medication, talk therapy, or just "community care"), all of the children had some problems later. They conclude that "Innovative treatment approaches targeting specific areas of adolescent impairment are needed."

"Steven Nissen: ADHD, Ritalin, and the HeartShould children get heart evaluations before taking stimulant medications for ADHD?

By Steven E. Nissen, M.D.

Posted March 25, 2009There have been reports that children taking Ritalin and other stimulants for attention deficit hyperactivity disorder can develop dangerous heart complications. Should a child have a heart evaluation before starting a stimulant?

This is a very actively debated controversy. The American Heart Association suggested that at a minimum, children should see their pediatrician. And you know, anytime people—whether adults or children—start a medication, they should be seen by a doctor and carefully evaluated with a physical examination, listening to the heart, and so on, for any murmurs or any other evidence of abnormality. The American Heart Association also recommended that an electrocardiogram, an EKG, be performed. The American Academy of Pediatrics issued a separate guideline saying that that was not necessary. In the final analysis, speak to your pediatrician, who best knows your own child.

I served on a Food and Drug Administration advisory panel that reviewed these drugs, and, in fact, I suggested that they needed a black-box warning, a strong warning, because of the heart risks. And I do support careful evaluation of the potential for heart-related adverse events in children, like sudden death, from heart arrhythmias. These are very rare, and no parent should be excessively concerned, but anything we can do to reduce the risk makes sense to me, and I feel an EKG is a very reasonable thing to do before taking these medications. What you're looking for is to see if there are any abnormalities that might make them higher risk to developing complications. And of course, if they have heart-related symptoms when they're already on the medication, they need to be evaluated."

And, to add further 'food for thought' to the original article...please read on:

It is a known fact that psychiatric mind-altering drugs, (Ritalin®, Adderall®, Concerta®, and so on), prescribed to children/adults for ADD (attention-deficit disorder) and ADHD (attention-deficit hyperactivity disorder) have a high potential risk in respect of adverse effects they can, (and do), create. There are, unfortunately, many documented cases.

Information that people generally may or may not be aware of is that there is also a connection between psychiatric drugs and violence. (This subject is not easy to digest mentally but I feel you will agree that we do need to face up to the truth. This is the only way to progress . . . eradication of agreed upon, unwanted influences in society, equals pro survival for humanity). Here are a few occurrences of where violence occurred in connection with psychiatric drugs:

On 14 February 2008, 27-year-old Steven Kazmierczak, DeKalb, Illinois, shot and killed five people and wounded 16 others before killing himself in a Northern Illinois University auditorium. According to his girlfriend, he had recently been taking Prozac, Xanax and Ambien. Toxicology reports showed that he still had trace amounts of Xanax in his system.

On 5 December 2007, 19-year-old Robert Hawkins, Omaha, Nebraska, killed eight people and wounded five before committing suicide in an Omaha mall. Hawkins' friend told CNN that the gunman was on antidepressants, and autopsy results confirmed he was under the influence of the "anti-anxiety" drug Valium.

On 7 November 2007, Jokela, Finland, 18-year-old Finnish gunman Pekka-Eric Auvinen had been taking antidepressants before he killed eight people and wounded a dozen more at Jokela High School in southern Finland, then committed suicide.

On 10 October 2007, Cleveland, Ohio, 14-year-old Asa Coon stormed through his school with a gun in each hand, shooting and wounding four before taking his own life. Court records show Coon had been placed on the antidepressant Trazadone.

On 16 April 2007, in Blacksburg, Virginia. The psychiatric drug history of Seung-Hui Cho in the Virginia Tech Massacre was never made public. Initial reports stated that "depression medication" was found among Cho's belongings. But neither his toxicology reports, nor his recent medical history were ever released to find out whether Cho had been in withdrawal from psychiatric medication. (33 were killed and 29 injured, but this was not included in the total of dead and wounded cited above).

On 20 April 1999, Columbine, Colorado, 18-year-old Eric Harris was on the antidepressant Luvox when he and his partner Dylan Klebold killed 12 classmates and a teacher and wounded 23 others before taking their own lives in the bloodiest school massacre in history. The coroner confirmed that the antidepressant was in his system through toxicology reports while Dylan Klebold's autopsy was never made public. Harris and Klebold underwent "anger management" and "death education" classes.

How many more disasters need to occur, similar to those listed above, before mind-altering psychiatric drugs, and their high potential risk of adverse effects on children/adults, are investigated, and accordingly preventive measures put in place? Could a couple of the underlying reasons for not taking action, be: ‘Drugs are big money', and, ‘Conflict of Interest' occurring, re sanctioning of mind-altering psychiatric drugs into society? If this is so, then it's at the expense of our children/adults, under continual threat of the high potential risks of ill effects being created from ingesting these psychiatric drugs!

The ever expanding environmental damage to our planet and the global financial economic crisis were both left, in the main, as unattended problems . . . until it was nearly too late!

A similar situation exists in respect of the inattention given to the ongoing critical problem and blatant disregard of conditions occurring from the continued introduction of these mind-altering psychiatric drugs into our society!

There are, thankfully, alternative, sane, workable solutions (holistic, nutritional, medical) in treating children/adults with attention, behavior or learning problems, (commonly called "ADD" or "ADHD"), (without, of course, the use of psychiatric drugs). Please view ‘Sources of Help' http://www.adhdtruth/testimonials.html for details.

My son takes Vyvanse for ADHD. It has made a huge difference in him. The trouble, however, is getting him to take the meds, as father tells him he doesn't need it. I think that for some people who actually have ADHD, the meds go a long way ... like removing that 50 pound back pack so they can run the same race as everyone else. I don't believe in drugging children just because they are hyper or have some behavior issues. I do, however, believe it is important to get them medical help if they indeed have a real medical condition, or imbalance, that can be improved through the use of medications. Along with that, discipline is important. It is difficult to discipline an ADHD child with a "time out", "grounding," or removal of his favorite things ... as ADHD children generally don't care and move on to something else quickly, and with very little thought about consequences. I want to know if anyone has successfully put their child in a "time out" without strapping them down. If so, how? Good luck!

I'm a 39 year old adult recently diagnosed with AD/HD. I tried giving up gluten, soy protein, casein protein, and egg-white protein, all of which I was supposedly allergic too and which supposedly was causing my AD/HD. I gave everything up for 3 months and ate a paleo diet. I know my physical health was improving but during this time, my AD/HD got worse because I was off everything I was addicted to... cheese, coffee, alcohol being the biggest addictions. I was off of work at the time and when I went back to work, I couldn't focus for 5 minutes. I didn't really have a choice, I have to take the meds. By doing so, I can stay employed at a job that pays well for someone who never got a college degree. People can interrupt me and it's not a big deal. I stay on track. If I could've taken a year off and focused on holistic health, maybe it would've gotten better, but I could not afford to lose my job and sense it made my AD/HD symptoms worse, it didn't seem fitting for me to give up everything that makes my life enjoyable. I know I've been different all my life and I have as a result of being un-diagnosed and not understanding myself have much social dysfunction. I wish I had knows about it earlier so that I could've had a different life. Who knew what I could've accomplished if I could've paid attention more? It's easy to make assumptions about people with AD/HD when you don't have it and you study all of us like specimens. Sadly, no one writes books or articles for us on how to understand the folks who DON'T have AD/HD. I don't feel like the meds hype me up or make me feel good. They calm me down and I am able to focus. It's ignorance to assume we're all getting high off these meds. We're getting focused. Being confident at work makes me feel good - not the drug itself. There's no high.